Key questions 1. Are mental health problems becoming more common amongst Australian workers? 2. How may work and the workplace be contributing to this? 3. What can workplaces do? 4. Upcoming launches / resources in Australia

Key questions 1. Are mental health problems becoming more common amongst Australian workers? 2. How may work and the workplace be contributing to this? 3. What can workplaces do? 4. Upcoming launches / resources in Australia

APS Stress and Wellbeing in Australia Survey • “In 2013, Australians reported significantly lower levels of wellbeing and significantly higher levels of stress and distress than in 2012 and 2011. • • Almost three-quarters of Australians (73%) reported that stress was having at least some impact with almost one in five (17%) reporting that stress was having a strong to very strong impact on their physical health.”

decades there has been a realization that mental well-being is not just the absence of mental disorder and should include concepts such as life satisfaction, fulfillment and making a contribution to society [20]. Towards this end, Keyes developed a concept of well-being on a continuum from flourishing to languishing that operated independently from measures of mental disorder, as demonstrated in figure 1 [21] Mental health is not just the lack of mental disorder Flourishing in terms of well-being Mental disorder No mental disorder Languishing in terms of well-being Figure 1: Diagram of the related, but distinct, concepts of mental disorder and mental wellbeing

So….is it this simple?

DSP in Australia by diagnosis

Are mental disorders becoming more common amongst working aged adults?

Idea that the modern workplace is ‘toxic’ to workers’ (and horses’!) mental health

Mental ill health amongst the working population is a huge problem, BUT….. • Rates of underlying mental health symptoms are not rising • Advances in treatment not flowing through to improved functional outcomes • Simple cause and effect models unlikely to reflect complexity of situation • Understanding this complexity can provide great opportunities for interventions • Many of the factors we are now investigating are much easier to address than “work stress”

Cautionary tail of debriefing • Popular intervention after trauma • Seemed like a sensible idea • When the research caught up, and proper trials conducted, found to be not effective and possibly harmful • Example of unexpected consequences and the need for good quality research

Key questions 1. Are mental health problems becoming more common amongst Australian workers? 2. How may work and the workplace be contributing to this? 3. What can workplaces do? 4. Upcoming launches / resources in Australia

What can be done? 1400 1200 Number of Articles 1000 800 600 400 200 0 Year

Meta-review of the literature Research questions: • How does work contribute to the development of depression and anxiety disorders? • What interventions have been effective in addressing depression and anxiety disorders in the workplace? • What are the costs associated with depression and anxiety disorders in the workplace? • How does work protect against, and contribute to the recovery from depression and anxiety disorders?

Workplace risk factors identified • Substantial body of evidence that in certain situations an individual’s work environment can contribute to the onset of depression and anxiety disorders. • Themes identified : – Psychological and social risk factors associated with the work environment – organisational change – employment status and job insecurity – exposure to potentially traumatic events while at work – job dissatisfaction

No such things as ‘simple’ mental health risk factors • The way in which the work environment impacts on an individual’s mental health is complicated. • The negative impact of some risk factors can, to some extent, be mitigated by other work factors • Organisational level factors, such as poorly managed change and the perceived fairness within an organisation, can also be important determinants of workers’ mental health

Job insecurity and organisational change • Good evidence from three longitudinal studies that those reporting job insecurity have around a 30% increase in the risk of common mental disorder • Systematic reviews have also confirmed a negative relationship between organisational change and poorer mental health, even amongst those who do not loose their job • Negative impacts may be greater if an employee perceives they have limited control over these changes

What about trauma? • Can learn a lot about the impacts of trauma from recent studies focused on the military • Much concern about ‘Gulf War Syndrome’ prior to recent deployments • Large epidemiological studies carried out during the recent conflicts in Iraq and Afghanistan

Can soldiers teach us anything? • Key points from recent studies of trauma in the military – PTSD less common than other problems, such as depression or substance misuse – Majority of people exposed to trauma are resilient, but a proportion have long term problems (up to 5 years follow up) – Organisational factors important – Good leadership and team cohesion can dramatically reduces the risk of PTSD – What most people exposed to trauma need is practical support and facilitation of their usual coping and peer support. 26

Key questions 1. Are mental health problems becoming more common amongst Australian workers? 2. How may work and the workplace be contributing to this? 3. What can workplaces do? 4. Upcoming launches / resources in Australia

What is psychological resilience? • Different people respond to stressors in different ways • Researchers tend to focus on those who get unwell….but most people remain well • Resilience can be considered a dynamic process which creates a positive adaption to adversity • Prevention of illness is a related, but not identical process

What about individual resilience training? • There is a lot of it about • Not that much evidence for workplace based resilience training • Is good evidence from other sectors (eg high school) that individual training can help prevent mental disorders • Best evidence approaches based around cognitive behavioural interventions

Systematic review of RCT of resilience training

Workplace based resilience training • Best evidence seems to be for interventions utilising cognitive behavioural techniques (CBT) and Acceptance and Commitment Therapy (ACT) • May allow individuals to intervene with controlling techniques early • Currently no good evidence for single session interventions • Possible role for e-health in the future

Organizational Justice • Organisational justice refers to the fairness of rules and social norms within companies • Distributive justice – fairness of resources and benefits distribution • Procedural justice - the methods and processes governing that distribution • Relational justice - the level of respect and dignity received from management

• 4237 non-depressed Danish public employees within 378 different work units • Mean levels of procedural and relational justice were computed for each work unit • Two years later, working in a work unit with low procedural justice (adjusted ORs of 2.50) and low relational justice (adjusted OR's of 3.14) predicted onset of depression. • Not much research on how an organization can increase its levels of organization justice

The role of managers • Managers have a crucial role • Wellbeing, handling incidents, early intervention, team morale, organizational justice, sickness absence management • Studies show that early and regular contact reduces the time of a sickness absence episode • Mental health literacy not enough, have to also be trained in the skills they need

HEALTHY WORKER Primary prevention SYMPTOMATIC OR AT RISK WORKER Secondary prevention MENTAL ILLNESS SICKNESS ABSENCE Tertiary prevention Once someone is off work due to a mental illness What doesn’t seem to work – standard symptom based treatments

What helps people get back to work? • Are effective treatments available for common mental disorders (depression and anxiety) • Can usually reduce symptoms • BUT….is now increasing evidence of a disconnect between symptom reduction and improvement in occupational outcomes • May be a delay in more subtle cognitive symptoms • Likely that there needs to be a greater rehabilitation focus from early in treatment

Key questions 1. Are mental health problems becoming more common amongst Australian workers? 2. How may work and the workplace be contributing to this? 3. What can workplaces do? 4. Upcoming launches / resources in Australia

Thank you s.harvey@unsw.edu.au www.wmh.unsw.edu.au

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